RANDOMIZED CONTROLLED TRIAL OF AN INTEGRATED BEHAVIORAL TREATMENT IN VETERANS WITH OBSTRUCTIVE SLEEP APNEA AND COEXISTING INSOMNIA

Insomnia disorder commonly occurs with obstructive sleep apnea (OSA), and may predict lower positive airway pressure (PAP) adherence. We tested a behavioral treatment integrating behavioral insomnia therapy with a PAP adherence program, in a 4-year randomized controlled trial among veterans with both disorders, to determine effects on sleep and objective PAP adherence. 125 veterans aged ≥ 50 (mean 63 years, 96% male, 42% non-Hispanic white), with OSA (apnea-hypopnea index ≥ 15) and insomnia (ICSD3 criteria) were randomized to 5 sessions of intervention (behavioral insomnia therapy integrated with a PAP adherence program, provided by nonclinicians supervised by behavioral sleep medicine specialists) or control (general sleep education). Outcomes (baseline, 3 and 6 months) included sleep onset latency (SOL-d), wake after sleep onset (WASO-d) and sleep efficiency (SE-d) by sleep diary; Pittsburgh Sleep Quality Index (PSQI); sleep efficiency by 7-day actigraphy (SE-a); and modem mean hours PAP use/night (PAPhrs) and number of nights used ≥ 4hrs (PAPnts), over the last 90 days. Analyses were intent-to-treat; mixed models with random intercepts (sleep) or t-tests (PAP adherence). Intervention participants had greater improvement than controls, between baseline and 3-months, and between baseline and 6-months, in SOL-d (17 and 16 min greater improvement at 3 and 6 months, respectively), SE-d (10.7% and 8.6%), SE-a (4.3% and 2.7%), and PSQI (3.2 and 1.7); all p